Lean transformation: getting hospital boards on board

September 07, 2017

​By: Christine Henhoeffer, Past Chair, Board of Trustees, St. Mary's General Hospital

The Lean journey is a continual transformation. It's not about making people work harder, but about removing non-value-added activities and waste so that staff can work more efficiently. This is a particularly important concept in health care, because Lean also improves value for patients. A board can, and should, play a significant role in supporting Lean transformation, and at St. Mary's General Hospital, it does.

Perhaps one of the biggest responsibilities a board has is oversight, particularly over cultural changes like Lean transformation. These kind of changes can represent a huge cost for an organization, so it's important for boards to truly understand Lean concepts and a Lean management system. There is simply no way a board can provide oversight unless its members are knowledgeable advocates of the process.

It has been a journey for us at St. Mary's, and not always an easy one for our volunteer board. The hospital entered into Lean in 2011, and in 2013 they brought in KPMG consulting, which is when the first significant request for funding came into the board. It was at that point that we decided we needed to understand Lean inside and out. We started by sending four board members to the ThedaCare Center for Healthcare Value (TCCHV) in Wisconsin, an education/consultancy/network-organization that aims to spread knowledge of Lean health care. I also worked closely with a KPMG consultant to do Lean generative discussions in order to build up our Board's expertise and knowledge.

Hospital staff have regular huddles where they meet to pass along information and updates during the day. Since our journey to understand Lean was so focused on learning and sharing, we decided to adopt the huddle concept. We now start off every board meeting with a 15-minute huddle facilitated by a board member and attended by members of the hospital's senior leadership team in order to discuss performance indicators. This was certainly a different experience for our board, but we decided that if hospital staff is challenged to implement one improvement per employee (we have 1300 staff) every year with a focus on  safety and patient improvement, it only made sense for the board to challenge itself to make board improvements too.

We have definitely improved as a board in time management and generative discussions, and we've put more responsibility on board members to make sure they come prepared to ask focused questions and challenge the hospital's senior leadership team in order to keep them accountable.

It's been hard to get the board fully immersed in Lean thinking, and part of that challenge lies in the fact that boards change all the time. New members come and go, so you do lose some of the knowledge and skill through natural attrition. That's why we changed our Skills Matrix for new members in 2014 so that we now specifically target those in the industry with Lean experience. We also continue to send members to TCCHV for Lean indoctrination.

There's quite an interest out there in understanding what St. Mary's is doing, since very few hospitals have this level of commitment to Lean, if at all. But the results speak for themselves.

You enter into Lean because you want to make things measurably better for staff, doctors, and volunteers, and because you want to make the journey for patients better, safer, and more streamlined. Over the past few years St. Mary's reduced C. difficile outbreaks by 63% (far surpassing our 25% goal), MRSA infection was reduced by 64% in 2016/17, and patient falls were reduced by 32% in 2014/15 and a further 24% in 2015/16. As part of our focus on a safer environment for staff, we reduced blood and body fluid injury by 26%.

We are seeing these results at St. Mary's because staff members are engaged in patient safety and process improvement, and because we have several Lean position champions, including the VP of Medical Affairs and our Chief of Staff. But it's also because the board has made understanding Lean a priority and has therefore been able to provide oversight over this huge and important transformation.

I will be talking more about how the board at St. Mary's General Hospital has been a Lean champion, during the Lean session at HealthAchieve, taking place on November 6 & 7 in Toronto. 

Article originally published on Canadian Healthcare Network 

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